---
title: PAInitiationRequest Elements
slug: electronic-prior-auth/guide/painitiationrequest-elements
docTags:
createdAt: 2026-06-18T17:59:40.007Z
---
:::hint{type="info"}
**Note: **Refer to the schema for a complete list of fields, including details for PAInitiationResponse elements.
:::
| **Element** | **Code** | **Comments** |
| -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------ | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **PAInitiationRequest**
**Note:** It is recommended to populate as many conditional elements as possible to maximize the prior authorization experience. | | |
| PAReferenceID | mandatory | Assigned by the prescribing system on the initial message and is used as a tracking identifier on all request and response prior authorization messages to tieback related prior authorization messages. The identifier must be unique per prescribing system for at least 18 months.
**Note:** PAReferenceID shall be established with the PARequest when responding to a Prior Authorization renewal request (unsolicited PAInitiationResponse). |
| PAPriorityIndicator | recommended | Indicates the requested PA processing priority. If PAPriorityIndicator is not populated, standard priority will be assumed.
Values:
**S** - Standard Priority
**X** - Urgent/Expedited Priority
**Note:** This value should be echoed on subsequent transactions. The priority may also be changed on the PARequest if the provider feels that the patient's health is at risk. |
| **BenefitsCoordination**
**Note: **The fields below may be returned in the Eligibility Response (271). If a PBM/payer returns active coverage, these fields should be populated with the returned value. Please see [Sending Prior Authorization Initiation Requests](docId\:f_ScGlkO2H5CdrO_Le8w0) for more detail**.** | | |
| PayerIdentification | conditional | |
| PayerID | conditional | Surescripts Participant ID assigned to the PBM/payer. |
| ProcessorIdentificationNumber | conditional | The PCN associated to the patient’s benefit. |
| IINNumber | conditional | The IIN associated to the patient’s benefit. |
| MutuallyDefined | conditional | The 271 message’s ISA13 control number. |
| PayerName | conditional | PBM/payer name. |
| CardholderID | conditional | Assigned cardholder ID for the patient.
**Note:** PBM/payers may validate patients based on cardholder ID. |
| CardHolderName | conditional | Cardholder name.
**Note:** PBM/payers may validate patients based on cardholder name. |
| GroupID | conditional | ID number identifying the health plan group. |
| GroupName | conditional | Name of the health plan group. |
| PBMMemberID | conditional | PBM/payer-assigned member ID for the patient. |
| **Patient**
**Note:** Refer to the schema for a complete list of fields. | | |
| Identification | mandatory | Usage requirements:
- If patient identification data exists, include the Identification element and populate its child elements.
- If no patient identification data is available, include the Identification element but leave it empty (no child elements). |
| SocialSecurity | conditional | Patient’s Social Security Number. Not recommended to send unless explicitly required by a specific business or regulatory process. |
| GenderAndSex | mandatory | Values:
- **M** - Male
- **F** - Female
- **U** - Not Specified or Unknown
- **N** - Non-binary - An umbrella term for people with gender identities that fall somewhere outside of the traditional conceptions of strictly either female or male. |
| PregnancyIndicator | conditional | Code indicating the patient as **pregnant** or **non-pregnant**. |
| Address | mandatory | Parent element for patient address information. |
| AddressLine1 | mandatory | Patient’s primary address line. |
| CIty | mandatory | Patient’s city. |
| StateProvince | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| PostalCode | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| **Prescriber**
**Note:** The prescriber relates to the person requesting the prior authorization. | | |
| Identification | mandatory | Some PBM/payers may validate prescriber data against NPPES or other prescriber directories using the fields under Identification. |
| NPI | mandatory | NPI of the prescriber. |
| Address | mandatory | Parent element for patient address information. |
| AddressLine1 | mandatory | Patient’s primary address line. |
| CIty | mandatory | Patient’s city. |
| StateProvince | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| PostalCode | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| **MedicationPrescribed** | | |
| DrugDescription | mandatory | Drug name (full drug name, strength, and form).
For a compound, the names of the ingredients in the compound or the prescriber’s preferred name should be communicated here.
See [DrugDescription](docId:3rtE--j4sQYuY-ywhpoIl) Best Practices section for more information. |
| DrugCoded | conditional | |
| NDC | mandatory | The NDC must be a valid 11-digit code and should meet the qualifications for a Representative NDC. |
| ProductCode | conditional | Product Identifier.
The Representative NDC is recommended unless the message contains Quantity Code List Qualifier “CF” or the CompoundInformation element is present. See [NDC Codes](docId:3rtE--j4sQYuY-ywhpoIl) for more information. |
| Strength | conditional | |
| StrengthForm/Code | conditional | Must be a valid FMT code. See [Codified Field Usage for Federal Medication Terminologies (FMT) Codes](docId\:b72tyNFwse2b-mCSxLvHL) for details. |
| StrengthUnitOfMeasure/Code | conditional | Must be a valid FMT code. See [Codified Field Usage for Federal Medication Terminologies (FMT) Codes](docId\:b72tyNFwse2b-mCSxLvHL) for details. |
| Quantity | mandatory | |
| QuantityUnitOfMeasure | mandatory | Must be a valid FMT code. See [Codified Field Usage for Federal Medication Terminologies (FMT) Codes](docId\:b72tyNFwse2b-mCSxLvHL) for details. |
| PADaysSupplyDosePerDay | conditional | MedicationPrescribed/DaysSupply or PADaysSupply and PADosesPerDay must be a whole number. Just one of these fields need to be submitted.
**Note:** In order to allow PBM/payers to provide the most accurate response, provider vendors should include DaysSupply for the requested medication within PAInitiationRequests. PBM/payers use days supply in order to determine if prescribers are requesting a quantity outside of the plan limit. Failure to provide days supply could result in unnecessary question sets being returned to prescribers or additional work. |
| Diagnosis | conditional | Provider vendors should send the valid version of diagnosis codes in the PAInitiationRequest. Sending diagnosis codes may speed up the process.
**Note:** If sending ICD-10 codes (Qualifier ABF), sending systems should not include decimal codes for message/submission. |
| ClinicalInformationQualifier | mandatory | Qualifier for how the diagnosis was obtained. Values:
**1** - Prescriber/Prescriber Supplied
**2** - Pharmacy Inferred
**3** - Patient
**4** - Other Source |
| Qualifier | mandatory | Defines the code list used for the diagnosis code. |
| Value | mandatory | Code for the diagnosis. |
| Description | mandatory | Description of the diagnosis code. |
| Sig | conditional | |
| SigText | mandatory | SigText will be used to convey patient instructions for use or administration and should be constructed and transmitted in a patient-friendly manner.
Sigs should not be truncated because important information can be lost. |
| **Provider**
**Note:** The provider loop can offer additional contacts beyond the prescriber if there were follow up questions to the PAInitiationRequest. | | |
| Identification | conditional | |
| NPI | mandatory | NPI of the initiating party. |
| Name | mandatory | Initiating party’s name. See ACR PA.204 in the [Application Certification Requirements](docId\:S0AzhQcpqwQHK9L9dQi1R) section for more information. |
| CommunicationNumbers | mandatory | |
| PrimaryTelephone | mandatory | Initiating party’s phone number. See ACR PA.204 in the [Application Certification Requirements](docId\:S0AzhQcpqwQHK9L9dQi1R) section for more information. |
| Fax | conditional | Initiating party’s fax number. |
| Address | mandatory | Parent element for patient address information. |
| AddressLine1 | mandatory | Patient’s primary address line. |
| CIty | mandatory | Patient’s city. |
| StateProvince | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| PostalCode | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |